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【进展】【主题活动】普外专业顶级英文期刊最新跟踪学习交流专贴－10月专题－肝移植 [精华]

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杂志全名及年卷期:Transplant Proc. 2007 Oct;39(8):2668-71.
题目：Use of marginal donors for liver transplantation: a single-center experience within the eurotransplant patient-driven allocation system.
作者：Lucidi V, Lemyé AC, Baire L, Buggenhout A, Hoang AD, Loi P, Mboti F, Mikhailski D, Closset J, Gelin M, Boon N, Degré D, Bourgeois N, Adler M, Donckier V.
Department of Surgery, Liver Transplantation Unit, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
英文摘要：BACKGROUND: Due to the organ shortage, marginal donors are increasingly used in liver transplantation (OLT). These grafts may be safely used in less critical recipients but, the real influence of extended donor criteria (EDC) remains uncertain when graft-recipient matching is not applied. Our study analyzed the impact of EDC on initial graft function within the Eurotransplant patient-driven allocation system. PATIENTS AND METHODS: We reviewed 70 OLT performed between 2004 and 2006. The impact of the following EDC were analyzed: age > 60; intensive care unit (ICU) stay > 4 days; peak serum Na(+) > 160 mEq/L; body mass index (BMI) > 30; cardiac arrest with cardiopulmonary resuscitation, and high doses of vasopressors. Early graft function, as defined according to peak transaminase level and spontaneous prothrombin time within the first 5 posttransplant days, was compared between the donors with none or one criterion (group A = 39) and those with >1 criterion (group B = 31). RESULTS: The most frequent EDC were high vasopressor use, ICU stay > 4 days and BMI > 30, were present in respectively 44%, 27%, and 16% of the donors. No EDC were present in 13 donors, one in 26, three in eight, and four in three. Demographics and origin and severity of the liver disease were similar in both groups. We failed to observe significant differences in initial graft function. CONCLUSION: The presence of EDC did not significantly affect early graft function in a population where donor and recipient were not matched. While this observation must be confirmed in a multicenter analysis, it tends to support the use of marginal liver grafts, even in patient-driven allocation systems.
PMID: 17954203 [PubMed - in process]
中文翻译：
杂志全名及年卷期：Transplant Proc. 2007 Oct;39(8):2668-71.
题目：用少量供体进行肝移植：欧洲移植门诊分流系统的单中心研究
作者：Lucidi V, Lemyé AC, Baire L, Buggenhout A, Hoang AD, Loi P, Mboti F, Mikhailski D, Closset J, Gelin M, Boon N, Degré D, Bourgeois N, Adler M, Donckier V
中文翻译：
背景：由于肝移植供体的短缺，少量肝供体在肝移植（OLT）中的使用迅速增长。这些移植供体可以比较安全的用于那些不是很严格的肝移植病人，但是但供体和受体并不匹配时，广大的供体标准（EDC）还是不很确定。我们的研究针对EDC在欧洲移植门诊分流系统中的起始作用。
病人和方法：我们重新翻阅了2004至2006之间的70例肝移植病人（OLT）。以下是EDC项目：年龄大于60岁，住ICU时间大于4天，血钠大于160 mEq/L，BMI>30,心肺复舒后心脏功能恢复的，高血压。在两组病人中，一组是不符合或只符合一个标准的（A=39），一组是符合一个以上的标准的病人（B=31），在术后5天内用转氨酶最高水平和凝血酶原水平评判早期供体功能。
结果：最常见的EDC病人是那些有高血压的，ICU居住大于4天的和BMI大于30的人，他们分别占了捐助者总数的44%, 27% 和 16%。有13个没有符合EDC标准，符合一项的有26个人，有 8个符合3项的，有3个人符合4项的。在两组中，原发的、严重的肝脏疾病都是相似的。我们并没有观察到早期供体的功能区别情况。
结论：当供体和受体并不能匹配的时候，目前的EDC在早期的供体功能评测中并不能发挥显著的作用。所以必须侧重于多中心研究，这样有利于对少量肝供体的使用，特别是在欧洲移植门诊分流系统中。
PMID: 17954203 [PubMed - in process]

个人认为：由于目前肝移植供体的短缺，我们应该尽量寻找供体的来源，可以制定一个供体选择标准，以更能有效的筛选有用的供体，以满足病人的需要。

2007-10-25 11:11

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• 综合医院全科门诊中乏力患者特征及就诊原因分析

yinxiaojun_hand

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杂志全名及年卷期：Transplant Proc. 2007 Oct;39(8):2601-2.
题目：Acquired renal cystic disease after liver transplantation in children.
作者：Franchi-Abella S, Mourier O, Pariente D, Frank-Soltysiak M, Bernard O, Debray D.
单位：Department of Pediatric Radiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
英文摘要：To our knowledge, the development of renal cystic disease that may contribute to kidney dysfunction has never been reported after liver transplantation. Herein we have reported on the fortuitous finding of renal cystic lesions upon computed tomographic scans (CT) in 33 (30%) of 108 pediatric liver transplant recipients who were the subjects of a prospective study evaluating long-term kidney dysfunction at 10 years after liver transplantation. The renal lesions had 2 different appearances: that of simple renal cysts and that of round lesions that were spontaneously hyperdense before contrast injection. These high-density lesions had a low signal on T2 weighted sequences, but 70% of them had been missed at ultrasonography. Their aspect upon CT and magnetic resonance favored cystic lesions filled with hemorrhagic or milk calcium content. Both types of cystic lesions were associated in 14 children. The renal lesions were significantly associated with moderate renal dysfunction, biopsy-proven chronic liver graft rejection, and thrombosis of the retrohepatic vena cava. The physiopathology of these lesions is undetermined. Two important questions need to be clarified with respect to the risk of progression of renal dysfunction associated with individual volume changes and/or increased number of renal cysts, as well as the risk of renal cancer as has been reported in dialyzed patients with acquired cystic kidney disease.
PMID: 17954188 [PubMed - in process]
中文翻译：
杂志全名及年卷期：Transplant Proc. 2007 Oct;39(8):2601-2
题目：儿童肝移植后的获得性肾脏囊性变
作者：Franchi-Abella S, Mourier O, Pariente D, Frank-Soltysiak M, Bernard O, Debray D.
中文摘要：据我们所知，关于肝移植后获得性肾脏囊性变并没有报道过，这个疾病会造成肾衰竭。在此，我们对108名肝移植后儿童通过CT检查偶然发现了有33名儿童患有获得性肾脏囊性变，这些儿童是肝移植后10年，进行前瞻性研究评价长期肾功能不全。肾脏损害有两方面表现：单一的肾脏囊性变和注射对比剂前的全面的、高密度的损害。这些高密度的损害在T2加权项是低信号的，但是70%的患者在超声检查中并没有发现。当肾脏囊性变中出现出血或钙化物时，它们在CT和磁共振中有反应。在14名儿童中同时出现了出血和钙化。这些肾脏损害与肾脏功能的缓慢衰竭、活检证实的肝脏排斥反应和移植肝的血管血栓形成有关。这些损害在病理生理学上并未很确定。有两个很重要的问题需要澄清，一个是肾脏囊性病变个数的增长与肾脏进行性衰竭的关系，一个是对于获得性的肾脏囊性变病人透析后得肾癌的危险性。
PMID: 17954188 [PubMed - in process]
个人观点：对病人来说，肝移植是个巨大的打击，全身各个系统都会有相应的变化，肾脏囊性病变也是其中之一，我们应该对肝移植病人密切关注，及时发现肾脏等相应器官病变，尽量改善患者的生活质量，延长患者的生命。

2007-10-25 11:50

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• 农村地区基层医疗卫生机构新型冠状病毒感染防控工作指引（第一版）

yinxiaojun_hand

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杂志全名及年卷期：Ann Transplant. 2007;12(1):11-4.
题目：Results of liver transplantation for hepatocellular cancer.
作者：Zieniewicz K, Patkowski W, Nyckowski P, Alsharabi A, Micha?owicz B, Pawlak J, Paluszkiewicz R, Wróblewski T, Najnigier B, Smoter P, Hevelke P, Skwarek A, Remiszewski P, Kotulski M, Skalski M, Paczek L, Krawczyk M.
Department of General, Transplant & Liver Surgery, Medical University of Warsaw, Poland. kzienie@amwaw.edu.pl

英文摘要：BACKGROUND: Liver transplantation (LTx) for hepatocellular carcinoma (HCC) in cirrhotic liver is nowadays generally accepted treatment modality. AIM OF
STUDY: Overview of the indications and results of the LTx in the patients with HCC, the first one performed in 2001. MATERIAL/METHODS: Among 357 adult liver transplant recipients in the period 1994-04.2005, in 26 (7%) the indication was HCC (16 men: 10 women, age 20-65, mean 46.5 years). HCC developed in cirrhotic liver in 25 pts. 12 (48%) were Child C, 10 (30%)--Child B and 3 (12%)--Child A patients. As underlying disease in 2 patients (8%) was alcoholic cirrhosis, in 7 (28%)--HBV cirrhosis, in 12 (48%)--HCV cirrhosis and in 4 (16%)--HBV/HCV cirrhosis. Milano criteria were met in 20 patients (77%). The mean waiting list time was 2.9 months (range 1-6 months). Seven patients underwent liverresection and 1 transarterial chemoembolization prior to LTx. 11 patients (42%) were operated on with use of veno-venous bypass, in 15 patients (58%) the piggy back technique was applied. Rapamycine based immunosuppression was preferred in post-LTx treatment. RESULTS: Operative mortality was 0.4 patients required relaparotomy for intraperitoneal bleeding. 21 patients (81%) are alive in good general condition, 19--free of the disease. 5 patients died 7-28 months after LTx (mean 16.7). The mean survival time is 20 months (range 1-38). CONCLUSIONS: Liver transplantation is safe and effective method of treatment of the selected patients with HCC in cirrhotic liver. Further investigations concerning the precise indications, timing of the transplantation and adjuvant treatment are necessary.

PMID: 17953137 [PubMed - in process]

中文翻译:
杂志全名及年卷期：Ann Transplant. 2007;12(1):11-4.
题目：肝移植治疗肝癌的结果
作者：Zieniewicz K, Patkowski W, Nyckowski P, Alsharabi A, Micha?owicz B, Pawlak J, Paluszkiewicz R, Wróblewski T, Najnigier B, Smoter P, Hevelke P, Skwarek A, Remiszewski P, Kotulski M, Skalski M, Paczek L, Krawczyk M.
摘要：
背景：现在肝移植（LTx）已经成为治疗肝细胞癌（HCC）所致肝硬化的一种可接受的治疗方法。
研究目的：概述那些从2001年开始统计的患HCC后进行LTx的病人和结果。
材料/方法：从1994年至2005.04的357个成人肝移植受者中，有26个病人（7%）患有HCC（16个男性：10个女性，年龄在20-65之间，平均年龄为46.5岁）。 HCC发展成肝硬化的有25人，其中12个（48%）肝功能分级为Child C，10个（30%）为Child B还有3个（28%）是Child A .有2个病人（8%）存在潜在的酒精性肝硬化，有7个（28%）是HBV性肝硬化，有12个（48%）是丙肝性肝硬化还有4例（16%）是乙肝、丙肝混合性肝硬化。有20个病人（77%）符合米兰标准。平均等待时间闻2.9个月（范围从1-6个月）。在进行LTx前，有7个病人经过肝脏切除还有一个经过了化疗的处理。有11个病人（42%）进行了静脉-静脉转流处理，15个人（58%）进行了背驮式处理。进行LTx前进行了免疫抑制。
结果：因腹腔出血行剖腹探查术的病人的手术死亡率为40%。21个病人（81%）生存情况良好，19个无患病。5个病人在LTx后7-28个月死亡（平均为16.7个月）。平均生存时间为20个月（范围是1-38个月）。
结论：选择性对ＨＣＣ伴肝硬化病人进行肝移植是个有效而安全的方法。对肝移植和辅助治疗的准确指标和时间进行长期的调查是有必要的。
PMID: 17953137 [PubMed - in process]

个人观点：
肝移植对对HCC患者来说是一个除手术和药物治疗以外的另一个方法之一，但是不是所有的HCC患者都有肝移植的指针，对于晚期HCC患者，特别是有远处转移的病人，肝移植就失去了它的意义。所以对于ＨＣＣ患者，我们应该充分进行评估，选择最好的时机进行肝移植，尽量延长患者的生存时间。

2007-10-25 18:27

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yinxiaojun_hand 编辑于 2007-10-25 19:43

• 第一次临床实操，你还记得吗？

yinxiaojun_hand

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杂志全名及年卷期：Transplant Proc. 2007 Oct;39(8):2514-5.
题目：Correlation between graft arterial anatomy and biliary complications after liver transplantation.
作者：Ferraz-Neto BH, Meira-Filho SR, Hidalgo R, Rezende MB, Zurstrassen MP, Thomé T, Fonseca LE, Pandullo FL, Afonso RC.
Albert Einstein Hospital, São Paulo, Brazil.
英文摘要：
Knowledge of the arterial vascular anatomy of the liver is important for orthotopic liver transplantation (OLT) because the lack of an adequate arterial blood supply results in biliary and parenchymal complications or graft loss. A number of reports have shown a relationship between aberrations of graft arteries and an increased incidence of early or late complications. Recent studies suggest no differences unless multiple anastomoses are required. The aim of this study was to report the incidence of aberrant hepatic arterial anatomy and its impact on vascular and biliary complications. We retrospectively reviewed data of 90 OLT performed on 82 patients, including 4 who underwent retransplantation from March 2003 to March 2006. The means recipient age was 52.47 years and 49 were men. The main caval vein reconstruction technique was piggyback (n = 55; 61.2%). The biliary reconstruction was performed by an end-to-end choledocho-choledocho anastomosis in 83 cases (92.3%) with choledocho-jejunal anastomosis (Roux-in-Y) in 7 cases (7.7%). Aberrant arterial anatomy was noted in 20 liver grafts (22.2%), namely, accessory right hepatic artery (n = 6; 6.6%), accessory left (n = 10; 11%), both accessory right and left (n = 3; 3.3%), and hepatic common artery from mesenteric artery (n = 1; 1.1%). Among the transplantations of grafts with aberrant arterial anatomy, 2 cases (10%) developed hepatic artery thrombosis (HAT) and 4 (20%) biliary complications. The rate of HAT and biliary complications among grafts with normal arterial anatomy was 3 and 8 cases (4.2% and 11.42%), respectively. Despite a greater number of complications among OLT with aberrant arterial anatomy, the Fisher test showed no significant relationship between HAT or biliary complications and aberrant arterial anatomy.
PMID: 17954161 [PubMed - in process]
杂志全名及年卷期：Transplant Proc. 2007 Oct;39(8):2514-5.
题目:肝移植术后移植动脉解剖结构与胆道并发症的关系
作者：Ferraz-Neto BH, Meira-Filho SR, Hidalgo R, Rezende MB, Zurstrassen MP, Thomé T, Fonseca LE, Pandullo FL, Afonso RC
摘要：
对肝动脉血管解剖的知识对原位肝移植来说是很重要的，因为如果缺乏足够的动脉血液供应，会导致胆道并发症或者移植物的损失。一组报告显示，畸变的移植血管跟肝移植的早期或晚期并发症的发病率有联系。最近的研究与上述报道并没有区别，除非有需要进行血管多重吻合。本研究的目的是解剖异常的肝动脉的发生率，以及他对血管和胆道并发症的影响。我们重新复习了2003年3月至2006年3月份的82个病人的90次肝移植的数据，包括四个经历了重复肝移植的病人。接受肝移植的病人平均年龄是52.47岁，并且有49个是男性。主腔静脉重建技术是背驮式（n=55个; 61.2 ％）。进行端端胆道吻合术的有83例（92.3%），还有7例进行了胆肠Roux-in-Y吻合。在20个肝脏移植（ 22.2 ％）中发现了迷走动脉，其中右肝动脉变异的有（ 6例; 6.6 ％），左肝动脉变异的有（ 10例; 11 ％），两侧都变异的的有(n = 3; 3.3%)，还有一例（1.1%)是肝动脉直接从肠系膜动脉出来。在有迷走动脉的移植体中，有2例（ 10 ％）发生肝动脉血栓（HAT）和4 例（ 20 ％）发生胆道并发症。HAT和胆道并发症在为正常动脉解剖的移植物中的发生率分别为3例和8例（ 4.2 ％和11.42 ％）。尽管动脉解剖异常的肝移植的病例并发症很多，但Fisher测试结果显示，在HAT或胆道并发症与异常动脉解剖并没有显著的联系。
PMID: 17954161 [PubMed - in process]
个人认为：
不论供者还是受者，肝血管解剖的变异会对肝脏的血供和血流动力学有影响，有必要在进行深入的研究。

2007-10-25 19:43

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• 首张“新冠患者分子全景图”

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